Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1696-1707
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1696
Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients
Antonella Delvecchio, Riccardo Inchingolo, Rita Laforgia, Francesca Ratti, Maximiliano Gelli, Massimiliano Ferdinando Anelli, Alexis Laurent, Giulio Vitali, Paolo Magistri, Giacomo Assirati, Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Tullio Piardi, Fabrizio di Benedetto, Nicola de'Angelis, Javier Briceño, Antonio Rampoldi, Renè Adam, Daniel Cherqui, Luca Antonio Aldrighetti, Riccardo Memeo
Antonella Delvecchio, Unit of General Surgery, "A. Perrino" Hospital, Ceglie Messapica 70124, Bari, Italy
Riccardo Inchingolo, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 75100, Italy
Rita Laforgia, Unit of Laparoscopic Surgery, University of Bari, Bary 70124, Italy
Francesca Ratti, Unit of Hepato-Pancreatic-Biliary Surgery, University Vita Salute San Raffaele, Milan 20132, Italy
Maximiliano Gelli, Department of Surgical Oncology, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
Massimiliano Ferdinando Anelli, Javier Briceño, Department of General Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
Alexis Laurent, Department of Digestive and Hepatobiliary Surgery, Henry Mondor University Hospital, Creteil 94000, France
Giulio Vitali, Division of Transplantation, Geneva University Hospital, Geneva 44041, Switzerland
Paolo Magistri, Giacomo Assirati, Fabrizio di Benedetto, Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
Tullio Piardi, Department of Digestive and Hepatobiliary Surgery, Robert Debrè University Hospital, Reims 51100, France
Nicola de'Angelis, Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
Antonio Rampoldi, Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
Renè Adam, Daniel Cherqui, Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
Luca Antonio Aldrighetti, Department of Hepatobiliary Surgery, University Vita Salute San Raffaele, Milan 20132, Italy
Riccardo Memeo, Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of “F. Miulli” General Regional Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riccardo Inchingolo, MD, Chief Doctor, Director, Doctor, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Strada Per Santeramo, Acquaviva delle Fonti 75100, Italy. riccardoin@hotmail.it
Received: July 22, 2021
Peer-review started: July 22, 2021
First decision: August 19, 2021
Revised: August 30, 2021
Accepted: November 1, 2021
Article in press: November 1, 2021
Published online: December 27, 2021
Processing time: 154 Days and 20.2 Hours
Abstract
BACKGROUND

Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.

AIM

To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.

METHODS

A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.

RESULTS

After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years.

CONCLUSION

Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival.

Keywords: Elderly; Hepatocellular carcinoma; Posterosuperior segments; Liver resection; Radiofrequency ablation; Multicentric study

Core Tip: A retrospective multicentric study was performed enrolling 77 patients with ≥ 70 years of age and a single hepatocellular carcinoma (≤ 30 mm), located in the posterosuperior segments (4a, 7, 8). Patients were divided into two groups: liver resection and radiofrequency ablation. Peri-operative and long-term outcomes were analyzed and compared using a 1:1 propensity score matching. The study results show that radiofrequency ablation in posterosuperior segments in elderly patients is safe and feasible and ensures a short hospital stay, reduces overall postoperative complications, increases the quality of life and does not modify the overall and disease-free survival.